Medical Practices Of Antietam LLC
Internal Medicine, Medical Oncology in Hagerstown, MD. Organization (NPI-2).
NPI number1962200501
StatusActive
Last updated in NPPESMar 7, 2025
Details
- NPI
- 1962200501
- Entity type
- Organization (NPI-2)
- Legal business name
- Medical Practices Of Antietam LLC
- Organization subpart
- No
- Enumeration date
- Mar 7, 2025
- Certification date
- Mar 7, 2025
- Last updated
- Mar 7, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RX0202X | Internal Medicine, Medical Oncology | – | – | Yes |
| 2086X0206X | Surgery, Surgical Oncology | – | – | |
| 208D00000X | General Practice | – | – |
Practice location
11110 Medical Campus Rd Ste 243Hagerstown, MD 21742-6756
Phone 301-665-4780
Mailing address
11116 Medical Campus RdHagerstown, MD 21742-6710
Authorized official
Joshua Repac
Cfo
3017909351
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